Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 797 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 20 21 34.634918 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 21 34.634918 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 6.593651 $329.6800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 11 103.000000 $5150.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.142857 $66.4100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.142857 $66.4100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 8 11 120.890475 $7024.9500 $58.1100
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Subtotal (Total Children Is Unduplicated) 22 30 232.769840 $12637.4500 $54.2900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 78 115 138.386692 $6919.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 24 27 27.230137 $680.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 103 110 116.041239 $5802.0800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 63 59.592858 $2979.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 29 27.172222 $1358.6100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 52 51.816667 $2590.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.505556 $62.6400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 170 222 1806.780955 $97566.2200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 11.000000 $594.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 29 203.484922 $16547.3900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 6 37.285714 $2428.0400 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 31 42 322.023810 $26186.9800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 43 375.621428 $30545.5500 $81.3200
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Subtotal (Total Children Is Unduplicated) 340 746 3182.942200 $194402.2000 $61.0800
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Total 797 3450.346958 $207039.6600 $60.0100
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Number of Children (Unduplicated) With at Least One Authorization 361